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Biocompatibility of New Calcium Aluminate Cement: Tissue Reaction and Expression of Inflammatory Mediators and Cytokines
Abstract
Introduction
The aim of this study was to evaluate the biocompatibility of a new calcium aluminate cement (EndoBinder) in subcutaneous tissue of rats in comparison with mineral trioxide aggregate and calcium hydroxide hard-setting cement.
Methods
Polyethylene tubes (1.5 × 10 mm) containing the dental cements were implanted into dorsal subcutaneous tissue of 30 rats. After experimental periods of 7, 30, and 90 days, biopsies were performed for tissue response analysis under optical light microscope. The mRNA extraction was performed for molecular evaluation of the inflammatory process in the peri-implant tissue, which was submitted to quantitative real-time polymerase chain reaction analysis for inflammatory mediators and cytokines TNF-α, Ptges2, Il-1β, Il-4, and Il-10.
Results
On the basis of the score used to grade the tissue reaction (0–3), EndoBinder (0) presented no inflammatory reaction after the 90-day period, a similar result to mineral trioxide aggregate and calcium hydroxide. The thickness of inflammatory capsules (μm) also presented significant decrease during the course of periods (P < .05). As regards expression of inflammatory mediators, Ptges2 and Il-10 were detected only at 7 and 30 days, with no statistically significant difference among the experimental groups (P > .05).
Conclusions
EndoBinder induced limited inflammatory reaction. It was considered biocompatible when tested in subcutaneous tissue of rats.
... Calcium aluminate-based biomaterials for use in endodontics have been investigated in the last decade and the available scientific literature provides limited data. Calcium aluminate cement Endobinder (Binderware, São Carlos, SP, Brazil) has shown good biological properties, while physical properties and shear bond strength to root dentin are comparable to other commercial materials based on calcium silicate [10,11,12]. In vivo studies that investigated the effect of calcium aluminosilicate material (Quick-Set) and white MTA found that these materials have a similar effect on dentin and cementum formation as well as periapical tissue healing in dogs after pulpotomy and application in root canals [13]. ...
... Biomaterijali na bazi kalcijum-aluminata za primenu u endodonciji se ispituju u poslednjoj deceniji i malo je dostupnih podataka u naučnoj literaturi. Kalcijum-aluminatni cement Endobinder (Binderware, São Carlos, SP, Brazil) pokazao je dobre biološke osobine, dok su fizička svojstva i adhezivnost za dentin komparabilna sa drugim komercijalnim materijalima na bazi kalcijum-silikata [10,11,12]. U in vivo studijama u kojima je ispitivan efekat kalcijum-aluminosilikatnog materijala (Quick-Set) i belog MTA utvrđeno je da ovi materijali imaju sličan efekat na formiranje dentina i cementa, kao i zarastanje periapikalnog tkiva kod pasa posle pulpotomije i aplikacije u korenske kanale [13]. ...
... Kalcijum-aluminatni cement sintetisan za primenu u endodonciji je u dostupnoj literaturi pokazao dobre rezultate u pogledu biokompatibilnosti posle supkutane i intraosealne implementacije kod eksperimentalnih životinja [10]. Moraes i saradnici su ukazali i na mogućnost primene kalcijum-aluminata kao skafolda i biomembrane u koštanoj regeneraciji [30]. ...
Introduction. ALBO-HA (Vinca, Serbia) is new nanostructured calcium aluminate cement, synthesized as a potential alternative to mineral trioxide aggregate (MTA). The purpose of this study was to compare the periapical tissue response to new nanostructured calcium aluminate cement ALBO-HA with white MTA (MTA Angelus, Londrina, Brasil) as root-filling material into the root canal of sheep?s teeth. Material and methods. Sixteen mandibular incisors from two 24-month-old sheep were used. Root canals were prepared and filled with ALBO-HA (group 1) or MTA (group 2) (eight teeth per group in each sheep). After four weeks the animals were sacrificed, teeth with surrounding tissue removed, and histologically processed. The sections were analyzed for determination of scores of the following parameters: periapical inflammatory infiltrate, newly mineralized apically formed tissue, apical periodontal ligament space thickness and resorption of dentin, cementum and bone. Data were analyzed statistically (?=0.05) using Mann-Whitney U test. Results. Slight inflammatory infiltrate was observed in 75.0% and 62.5% of samples in the group 1 and group 2, respectively (p>0.05). Partial newly mineralized apically formed tissue was found in 75.0% of samples in the group 1, and 87.5% of samples in group 2 (p>0.05). No significant difference was noted for periodontal ligament space thickness (p>0.05). Resorption of dentin, cementum or bone was not observed. Conclusion. ALBO-HA and white MTA Angelus had a similar effect on inflammation, newly mineralized apical tissue formation and thickness of periodontal ligament space after root canal filling under the present experimental conditions.
... In order to overcome the limitations of MTA, new biomaterials, such as calcium aluminate cements (CACs), have been proposed and constantly evaluated in terms of their physicochemical, mechanical, and biological properties [7][8][9]. EndoBinder (Binderware, São Carlos, SP, Brazil -Patent Number PI0704502-6) is a CAC, and it has clinical applications similar to MTA, especially when used for pulp-capping, root perforations repair, and apical surgery as a retrograde filling material [7][8][9][10]. Studies demonstrated that EndoBinder has similar biocompatibility and cytocompatibility to MTA [9,10]. ...
... In order to overcome the limitations of MTA, new biomaterials, such as calcium aluminate cements (CACs), have been proposed and constantly evaluated in terms of their physicochemical, mechanical, and biological properties [7][8][9]. EndoBinder (Binderware, São Carlos, SP, Brazil -Patent Number PI0704502-6) is a CAC, and it has clinical applications similar to MTA, especially when used for pulp-capping, root perforations repair, and apical surgery as a retrograde filling material [7][8][9][10]. Studies demonstrated that EndoBinder has similar biocompatibility and cytocompatibility to MTA [9,10]. ...
... EndoBinder (Binderware, São Carlos, SP, Brazil -Patent Number PI0704502-6) is a CAC, and it has clinical applications similar to MTA, especially when used for pulp-capping, root perforations repair, and apical surgery as a retrograde filling material [7][8][9][10]. Studies demonstrated that EndoBinder has similar biocompatibility and cytocompatibility to MTA [9,10]. According to Garcia et al. [8], the mechanical resistance of EndoBinder is greater than MTA. ...
Objectives:
This study evaluated the effect of different nanoparticulated zinc oxide (nano-ZnO) and conventional-ZnO ratios on the physicochemical properties of calcium aluminate cement (CAC).
Materials and methods:
The conventional-ZnO and nano-ZnO were added to the cement powder in the following proportions: G1 (20% conventional-ZnO), G2 (15% conventional-ZnO + 5% nano-ZnO), G3 (12% conventional-ZnO + 3% nano-ZnO) and G4 (10% conventional-ZnO + 5% nano-ZnO). The radiopacity (Rad), setting time (Set), dimensional change (Dc), solubility (Sol), compressive strength (Cst), and pH were evaluated. The nano-ZnO and CAC containing conventional-ZnO were also assessed using scanning electron microscopy, transmission electron microscopy, and energy-dispersive X-ray spectroscopy. Radiopacity data were analyzed by the 1-way analysis of variance (ANOVA) and Bonferroni tests (p < 0.05). The data of the other properties were analyzed by the ANOVA, Tukey, and Fisher tests (p < 0.05).
Results:
The nano-ZnO and CAC containing conventional-ZnO powders presented particles with few impurities and nanometric and micrometric sizes, respectively. G1 had the highest Rad mean value (p < 0.05). When compared to G1, groups containing nano-ZnO had a significant reduction in the Set (p < 0.05) and lower values of Dc at 24 hours (p < 0.05). The Cst was higher for G4, with a significant difference for the other groups (p < 0.05). The Sol did not present significant differences among groups (p > 0.05).
Conclusions:
The addition of nano-ZnO to CAC improved its dimensional change, setting time, and compressive strength, which may be promising for the clinical performance of this cement.
... As many studies have reported the deleterious effects of the addition of Bi 2 O 3 on the biocompatibility and bioactivity of mineral aggregate-based cements (Aguilar, Roberti Garcia, & Panzeri Pires-de-Souza, 2012;de Souza Costa et al., 2014;Garcia et al., 2015;Garcia, Huck, Magalhães, Souza, & Souza Costa, 2017;Garcia, Huck, Menezes de Oliveira, de Souza, & de Souza Costa, 2014;Hoshyari et al., 2016;Huck et al., 2017;Yaltirik, Ozbas, Bilgic, & Issever, 2004), alternative radiopacifiers have been proposed, such as calcium tungstate (CaWO 4 ) (Bosso-Martelo et al., 2016), zirconium oxide (ZrO 2 ) Viapiana, Flumignan, Guerreiro-Tanomaru, Camilleri, & Tanomaru-Filho, 2014), zinc oxide (ZnO) Huck et al., 2017), niobium oxide (Nb 2 O 5 ) (Bosso-Martelo et al., 2016) and barium sulfate (BaSO 4 ) (Camilleri, 2010;Camilleri & Gandolfi, 2010). ...
... Thirty-six young adults male Wistar rats (Rattus norvegicus), weighing between 250 and 300 g, were selected for this study. The number of animals was based on several similar studies (Aguilar et al., 2012;de Souza Costa et al., 2014;Garcia et al., 2017;Garcia, Huck, et al., 2014) and on the three Rs (Replacement, Reduction and Refinement) in Animal Research principles (Russell & Burch, 1959). During the whole experimental procedure, the animals were accommodated in acclimatized bioterium (21-23 C/12-hr light-dark cicle) and received balanced rations (Nuvilab, Colombo, PR, Brazil) and water ad libitum, strictly following the guidelines of the National Institutes of Health guide for the care and use of Laboratory animals (NIH Publications No. 8023, revised 1978). ...
... The histopathological analysis was performed in a double-blind manner by two experienced and previously calibrated pathologists. A Kappa test was performed between the examiners, and the results ranged from 0.81 to 1.00 (considered as almost perfect Garcia et al., 2017;Garcia, Huck, et al., 2014). Based on these histopathological features, the following criteria was used to grade the tissue reaction: −0inflammation absent (0-10 inflammatory cells/area); −1mild inflammation (11-25 cells); −2moderate inflammation (26-65 cells); and − 3-severe inflammation (more than 65 inflammatory cells/area) (Aguilar et al., 2012;de Souza Costa et al., 2014;Garcia et al., 2017;Garcia, Huck, et al., 2014). ...
The purpose of this study was to investigate the tissue reaction stimulated by BaSO 4-and Bi 2 O 3-containing White MTA Angelus, in comparison with Bi 2 O 3-containing white Portland cement, and white ProRoot MTA. Thirty-six adult male Wistar rats (Rattus norvegicus), weighing between 250 and 300 g, were distributed into three groups (n = 12) in accordance with the period of sacrifice (15, 30, and 60 days). Four polyethylene tubes filled with the tested cements were implanted into the dorsum of each rat. Lateral wall of the tubes served as the negative control. After the experimental periods, the animals were euthanized by overdose of pentobarbital anesthetic solution, and the specimens were prepared for microscopic analysis under
... Inflammatory reaction of the tissues that were in contact with the material on the open end of the tubes were scored, according to previous studies (1,8), as follows: 1, no or few inflammatory cells and no reaction; 2, fewer than 25 cells and mild reaction; 3, between 25 and 125 cells and moderate reaction; 4, 126 or more cells and severe reaction. In addition, these scores were also applied to the separate counting of macrophages (10,11). The amount of fibroblasts was evaluated through the application of scores adapted from Garcia et al. (10,11), as follows: 1, no or few fibroblasts; 2, fewer than 25 fibroblasts; 3, between 25 and 125 fibroblasts; 4, 126 or more fibroblasts. ...
... In addition, these scores were also applied to the separate counting of macrophages (10,11). The amount of fibroblasts was evaluated through the application of scores adapted from Garcia et al. (10,11), as follows: 1, no or few fibroblasts; 2, fewer than 25 fibroblasts; 3, between 25 and 125 fibroblasts; 4, 126 or more fibroblasts. All analyses were performed using magnification of 400× in center on the open of the tube. ...
... Most materials that could be used for cavity repair have been made available with the need for operator manipulation (1,10,11). This study investigated a new bioceramic repair material that does not need to be manipulated, ready-to-use Bio-C Repair, and showed that this material presents cytocompatibility, along with a biocompatibility and biomineralization capacity that is similar to MTA-HP and white MTA-Ang, accepting the null hypothesis. ...
New mineral trioxide aggregate (MTA) formulations are constantly introduced in the market, usually in a powder-and-liquid form. Bioceramic (Bio-C) Repair is a ready-for-use material suggested as substitute for MTA, but its properties need to be studied. This study evaluated the cytotoxicity, biocompatibility and biomineralization of Bio-C Repair compared to MTA Repair High-Plasticity (MTA-HP) and white MTA-Angelus (MTA-Ang). L929 fibroblasts were exposed to material-extracted (undiluted, ½ and ¼ dilutions; 6, 24 and 48h). Polyethylene tubes with material or empty (control) were implanted in the subcutaneous tissue of rats. After 7 and 30 days (n=8), the specimens were removed for analysis (hematoxylin-eosin, von Kossa and polarized light). Cytotoxicity data were statistically analyzed by two-way ANOVA, and biocompatibility data by Kruskal-Wallis and Dunn tests (p<0.05). The cells exposed to the materials had greater viability at most of the periods compared with control (p<0.05). The undiluted and ½ dilutions of MTA-HP extract showed higher cytocompatibility than Bio-C Repair at 6 h and with the ¼ dilution at 24 h (p<0.05); the white MTA-Ang showed higher cytocompatibility than Bio-C Repair at most of periods (p<0.05). The undiluted white MTA-Ang extract had higher cytocompatibility at 6 and 24h than MTA-HP, and with ½ dilution at 24h (p<0.05). The materials’ cytocompatibility was similar at 48h for most dilutions (p>0.05). At 7 and 30 days, the groups had moderate and mild inflammation, respectively (p>0.05). All materials showed positive structures for von Kossa and polarized light. In conclusion, Bio-C Repair had similar cytocompatibility to MTA-based materials is biocompatible and induces biomineralization.
... As the tested biomaterials were basically composed by three different components, the sum of their effects provided some of the results obtained in the present study. Garcia et al. (20) evaluating the local biocompatibility of calcium aluminate cement, observed an inflammatory response in the subcutaneous tissue of rats with a pattern similar to the one obtained in the present study. This was also observed when the calcium aluminate cement was used for filling bone defects, with continuous reduction in the amplitude of the inflammatory infiltrate and linear closure of the experimental defects along the times of analysis (12). ...
... Saghiri et al. (19) reported that inflammatory infiltrate tended to diminish with the course of time, and the higher the medium pH, the more evident would be the inflammatory response. With time, the calcium aluminate tended to stabilize the medium pH, turning it alkaline due to the release of Ca 2+ ions (13), which produced a favorable environment for tissue repair (13,20). This may have been crucial for the inflammatory response over the course of the experimental time intervals, and for the pattern of tissue repair observed in the groups submitted to implantation of the biomaterials and the negative control group (blood clot), which resulted in significant difference in the final period of analysis. ...
... Concerning new bone formation, in all the evaluated groups, in the initial time interval of seven days, there was formation of immature bone tissue and local neovascularization. The great advantage of this new class of biomaterials is their capacity for stimulating early vascular invasion (20). Thus, in the other time intervals (15 and 30 days) there was formation of a bone tissue with the tendency to linear closure of the defect. ...
Innovative biomaterials can provide a promising new direction for the treatment of bone defects, stimulating a proper repair process, with no damage to adjacent tissues. The purpose of this in vivo study was to evaluate the biocompatibility and the osteoinductive capacity of chitosan-collagen biomembrane and scaffold containing calcium aluminate cement. Eighteen New Zealand white rabbits (Oryctolagus cuniculus) were distributed according to the experimental times of analysis (7, 15 and 30 days). Four bone defects were created in the rabbits calvaria, which were individually filled with the biomembrane, scaffold, blood clot (negative control) and autologous bone (positive control). Histopathological analysis was performed using optical microscope at 32´, 64´, 125´ and 320´ magnifications. Cell response to inflammation and new bone tissue formation was quantified using a score system. The biomembrane group presented greater inflammatory response at 15 days, with significant difference to autologous bone group (p<0.05). There was no statistically significant difference for foreign body type reaction among groups (p>0.05). Concerning new bone formation, linear closure of the defect area was observed more evidently in the group with autologous bone. The scaffold group presented similar results compared with the autologous bone group at 30 days (p>0.05). Both tested biomaterials presented similar biocompatibility compared with the control groups. In addition, the biomembrane and scaffold presented similar osteoinductive capacity, stimulating bone repair process in the course of the experimental time intervals.
... This mode of synthesis provides high particle activity, faster hydration and short setting time [7]. Calcium aluminate cements have been specifically studied for use in dentistry [8,9,10]. Up to date in in vitro studies, nanostructured calcium aluminate did not show cytotoxic and genotoxic effects in the culture of human fibroblasts MRC-5, while in an in vivo study in experimental animals it showed satisfactory biocompatibility [11,12]. ...
... Ovakav način sinteze obezbeđuje visoku aktivnost čestica, bržu hidrataciju i kratko vreme vezivanja [7]. Kalcijum-aluminatni cementi su posebno proučavani za upotrebu u stomatologiji [8,9,10]. U dosadašnjim ispitivanjima u in vitro uslovima nanostrukturni kalcijum-aluminat nije ispoljio citotoksični i genotoksični efekat u kulturi humanih fibroblasta pluća MRC-5, dok je u in vivo studiji na eksperimentalnim životinjama pokazao dobru biokompatibilnost [11,12]. ...
Introduction Materials used for root canal obturation and root perforation are expected to have, in addition to preventing apical, lateral and coronary leakage, antimicrobial effects on microorganisms that are not accessible to chemo-mechanical instrumentation and intra-canal medications. The aim of this study was to evaluate the antimicrobial effect of a novel calcium aluminate-based endodontic nanostructured biomaterial (ALBO-MCCA) using agar diffusion test. Material and methods The two materials were tested in the study. The nanostructured calcium aluminate was synthesized by the hydrothermal sol-gel method from individual components of calcium aluminate (CaOxAl 2 O 3), calcite (CaCO 3) and barium sulfate (BaSO 4) as radiocontrast agent in the ratio of 2:2:1 according to V. Jokanovic's recipe. The other used material was calcium silicate MTA Angelus (Londrina, Brazil). The antimicrobial effect was assessed using agar diffusion test. Standard strains of Enterococcus faecalis, Escherichia coli, Staphylococcus aureus, cultured on blood Mueller-Hinton agar and Candida albicans cultivated on Sabouraud Dextrose Agar, were used as test microorganisms. Results The best antimicrobial effect after 24 h both materials showed against S. aureus. The mean values of the growth inhibition zone for ALBO MCCA were 5.7 ± 0.25 mm and MTA 6.2 ± 0.4 mm. The ALBO MCCA material showed slightly stronger antibacterial effect against E. coli compared to MTA (p < 0.05), whereas none of the materials showed antibacterial effect against E. faecalis. Conclusion The ALBO MCCA material showed certain antibacterial effect on Escherichia coli, Staphylococcus aureus and Candida albicans that was comparable to antibacterial effect of MTA.
... Previous studies reported that the rate of calcium ion release of MTA was significantly compromised due to the presence of Bi 2 O 3 in its composition (6,7). However, various in vivo studies that assessed the biocompatibility of this cement (21,22) demonstrated that after 30 days, the material allowed adequate tissue repair, indicating that the alkaline pH produced by calcium ion release was maintained (22,23). It is believed that this ability to maintain the alkaline pH of the medium is the main responsible for the excellent biological performances of MTA and EndoBinder (21). ...
... Previous studies reported that the rate of calcium ion release of MTA was significantly compromised due to the presence of Bi 2 O 3 in its composition (6,7). However, various in vivo studies that assessed the biocompatibility of this cement (21,22) demonstrated that after 30 days, the material allowed adequate tissue repair, indicating that the alkaline pH produced by calcium ion release was maintained (22,23). It is believed that this ability to maintain the alkaline pH of the medium is the main responsible for the excellent biological performances of MTA and EndoBinder (21). ...
This study aimed to evaluate the cytotoxicity of a calcium aluminate cement (EndoBinder) containing different radiopacifiers, Bi2O3, ZnO or ZrO2, compared with Mineral Trioxide Aggregate (MTA). According to ISO 10993-12:2012 (E) recommendations, 0.2 g of each cement were applied in transwell inserts and placed in 24-well culture plates containing 1 mL of culture medium (DMEM). After 24 h of incubation, the extracts (DMEM containing components released from the cements) were applied to immortalized odontoblast-like MDPC-23 cells. Cell viability (MTT test), alkaline phosphatase activity (ALP), total protein production and cell morphology (Scanning Electron Microscopy - SEM) were evaluated. The volume of 50 µL of extract was used to determine the chemical elements released by the cements using Energy Dispersive Spectroscopy (EDS). The following groups were established (n=6): NC - negative control (without treatment); EB - EndoBinder without radiopacifier; EBBO - EndoBinder+Bi2O3; EBZnO - EndoBinder+ZnO; EBZrO - EndoBinder+ZrO2 and WMTA - White MTA. Data were subjected to statistical analysis (Kruskal-Wallis test, level of significance=5%). Cells exposed to the different versions of EndoBinder presented small reduction in viability, total protein production and ALP activity, with values similar to the NC and WMTA groups (p>0.05). Different elements (C, O, Na, Al, P, Si, Cl, Bi, K) released by the cements were detected in the extracts. However, the cells had no significant changes in their morphology. EndoBinder and MTA did not affect negatively the metabolism of the odontoblastic-like cells, showing it to be cytocompatible, irrespective of the used radiopacifier.
... 10,11,12,13,14 Recently, researchers have found calcium-aluminate to be a promising mineral phase for both dentin and bone regeneration, since several levels of Ca ++ release and neutral pH may be achieved, depending on the production route, which has a direct effect on cell differentiation. 15,16,17,18,19 Therefore, human dental pulp cells were used in the present investigation to assess the dentinogenic potential of a novel biomembrane composed of chitosan and collagen containing calcium-aluminate as a mineral phase. ...
... Calcium-aluminate in contact with a wet environment leads to the formation of the AH3 (Al 2 O 3 .3H 2 O) and C3AH6 (3CaO.Al 2 O 3 .6H 2 O) phases, associated with the release of low amounts of Ca ++ , which maintains pH levels similar to those of human body tissues, 17 and leads to the formation of a carbonated apatite phase. 34 The biocompatibility of this material, reported previously, 16,18 seems to be related to the slightly alkaline pH level (about 8.0) achieved after its application to the connective tissues. 17,19 According to the results, the pulp cells seeded onto the BM presented faster proliferative capability at the initial periods, in comparison with those of the NC group. ...
The development of biomaterials capable of driving dental pulp stem cell differentiation into odontoblast-like cells able to secrete reparative dentin is the goal of current conservative dentistry. In the present investigation, a biomembrane (BM) composed of a chitosan/collagen matrix embedded with calcium-aluminate microparticles was tested. The BM was produced by mixing collagen gel with a chitosan solution (2:1), and then adding bioactive calcium-aluminate cement as the mineral phase. An inert material (polystyrene) was used as the negative control. Human dental pulp cells were seeded onto the surface of certain materials, and the cytocompatibility was evaluated by cell proliferation and cell morphology, assessed after 1, 7, 14 and 28 days in culture. The odontoblastic differentiation was evaluated by measuring alkaline phosphatase (ALP) activity, total protein production, gene expression of DMP-1/DSPP and mineralized nodule deposition. The pulp cells were able to attach onto the BM surface and spread, displaying a faster proliferative rate at initial periods than that of the control cells. The BM also acted on the cells to induce more intense ALP activity, protein production at 14 days, and higher gene expression of DSPP and DMP-1 at 28 days, leading to the deposition of about five times more mineralized matrix than the cells in the control group. Therefore, the experimental biomembrane induced the differentiation of pulp cells into odontoblast-like cells featuring a highly secretory phenotype. This innovative bioactive material can drive other protocols for dental pulp exposure treatment by inducing the regeneration of dentin tissue mediated by resident cells.
... In line with these findings, another study investigated the effects of NeoPutty on human dental pulp stem cells and human periodontal ligament fibroblasts and found that these repair materials showed acceptable cytocompatibility profiles on both cell types [18]. It is worthy to mention that NeoPutty contains calcium aluminate that has been shown to have adequate biocompatibility after subcutaneous implantation in rats [55] and also supported the acquisition of osteogenic cell phenotypes in vitro [56]. ...
To investigate the effect of three different calcium silicate-based materials (CSBM) on the biological behavior of human periodontal ligament stem cells (hPDLSCs).
Eluates of Biodentine, NeoPutty and TheraCal PT prepared at 1:1, 1:2, and 1:4 ratios were extracted under sterile conditions. The cytotoxicity of the extracts to the hPDLSCs was assessed using the MTT assay. Scratch wound healing assay was utilized for assessing cell migration. Scanning electron microscopy was used to detect cell attachment and morphology. Calcium ion release was measured using inductively coupled plasma-optical emission spectrometry; the pH-value was evaluated with a pH-meter. ANOVA with post hoc Tukey test was used for statistical analysis.
Cell viability was significantly higher for Biodentine and NeoPutty at day 1 with all dilutions (p < 0.05), while at day 3 and day 7 with dilutions 1:2 and 1:4; all materials showed similar behavior (p > 0.05). Biodentine had the highest percentage of cell migration into the scratched area at day 1 for all dilutions (p < 0.05). Stem cells were attached favorably on Biodentine and NeoPutty with evident spreading, and intercellular communications; however, this was not shown for TheraCal PT. Biodentine showed the highest pH values and calcium ion release (p < 0.05).
The resin-free CSBM showed better performance and favorable biological effects on hPDLSCs and were therefore considered promising for usage as endodontic repair materials.
Clinical significance: Proper selection of materials with favorable impact on the host stem cells is crucial to ensure outcome in different clinical scenarios.
... In addition, the hydroxide ions contribute to the development of an enzymatic inhibition of the bacteria, which results in the antibiotic action of the substance. [25] Clinical research with long-term follow-ups has shown that Calcium hydroxide pulp capping has highly variable success rates, is usually unexpected, and frequently shows ineffective outcomes. [26,27] In fact, DPC with calcium hydroxide is no longer recommended. ...
The field of dentistry is rapidly shifting its focus toward biologically active restorative materials. Bioactive materials are those capable of inducing and promoting the regeneration of the damaged tissue and remineralizing demineralized dentinal structure as a vital dental pulp is necessary for the long-term healthy survival of a tooth. Vital pulp therapy intends to protect and prevail the vitality of pulp tissue which gets compromised when subjected to mutilating factors like dental caries, trauma, and operative or restorative procedures. During the therapy, the said bioactive material initially forms a non-irritant protective bridge over the vital pulp and later stimulates the pulpal odontoblasts to produce a reparative dentinal barrier which later forms a barrier and protects the underlying pulp’s vitality. The vitality of a tooth needs to be intact protected because the consensus reports that endodontically treated teeth, particularly molars, reportedly have a reduced survival probability than the vital teeth. [1] These factual arguments lead to the development of biologically active restorative materials. This review article intends to provide a review of the modern products introduced in the category of bioactive restorative materials.
... Calcium aluminate has been shown to support the acquisition of osteogenic cell phenotypes in vitro [37]. In addition, calcium aluminate-containing materials have shown adequate biocompatibility after subcutaneous implantation in rats [38]. As expected, MTA Angelus did not show tantalum peaks, since tantalum oxide is not reported in its composition. ...
Objectives
The aim of the present in vitro study is to determine the cytocompatibility of the recently introduced NeoPutty in contact with human dental pulp cells compared with its precursor NeoMTA Plus and the classic gold standard MTA Angelus.
Materials and methods
Sample disks were obtained for each of the tested materials (5 mm diameter; 2 mm thickness; n = 30), along with 1:1, 1:2, and 1:4 material eluents. HDPCs were extracted and cultured with the tested materials (test groups) or in unconditioned medium (control group), and the following biocompatibility assays were performed: MTT assay, scratch wound assay, cell cytoskeleton staining assays, and cell attachment assessment via SEM. Additionally, material ion release and surface element composition were evaluated via ICP-MS and SEM–EDX, respectively. Each experimental condition was carried out three times and assessed in three independent experiments. Statistical significance was established at p < 0.05.
Results
1:2 dilutions of all the tested materials exhibited a comparable cell viability to that of the control group at 48 and 72 h of culture ( p < 0.05). The same was observed for 1:4 dilutions of the tested materials at 24, 48, and 72 h of culture ( p > 0.05). All the tested materials exhibited adequate cytocompatibility in the remaining biocompatibility assays. MTA exhibited a significantly higher calcium ion release compared to NeoPutty and NeoMTA Plus ( p < 0.05).
Conclusion
The results from the present work elucidate the adequate cytocompatibility of NeoPutty, NeoMTA Plus, and MTA Angelus towards human dental pulp cells.
Clinical relevance
Within the limitations of the present in vitro study, our results may act as preliminary evidence for its use in vital pulp therapy as a pulp capper. However, results need to be interpreted with caution until further clinical supporting evidence is reported.
... Calcium aluminate cement (CAC) has clinical applications similar to MTA [7]. Among the desirable properties of CAC, it is worth to mention its biocompatibility [8,9], bioactivity [10,11], high mechanical strength [12] and antimicrobial activity [13]. Conversely, CAC also has poor handling characteristics, which hinders its clinical use [14]. ...
The purpose of this study was to investigate whether the root perforation repair with mineral aggregate-based cements affects the retention of customized fiberglass posts to bovine intraradicular dentin. Sixty-four bovine mandibular incisors had their root canals endodontically treated and prepared for fiberglass posts luting. Teeth were randomly distributed into four groups (n = 16), according to the cement used for the perforations repair (MTA HP; calcium aluminate cement-CAC; and CAC + calcium carbonate nanoparticles-nano-CaCO3) and control group (no perforation). The groups were redistributed according to the fiberglass posts luting protocol (n = 8): total-etching (TE) (MTA HP/TE; CAC/TE; CAC + CaCO3/TE and control/TE) and self-etching (SE) (MTA HP/SE; CAC/SE; CAC + CaCO3/SE and control/SE). Roots were sectioned into 1.3 mm-thick dentin slices obtaining samples that were submitted to the push-out test in Universal Testing Machine (Instron, Model 4444-0.5 mm/min). The fractured samples were analyzed under stereomicroscope and Scanning Electron Microscope (SEM). CAC/TE and CAC/SE groups had significant difference between the cervical and middle thirds (p < 0.05). When the root thirds were not considered, CAC/SE had the lowest bond strength and differed statistically from CAC/TE and CAC + CaCO3/TE groups, which had the highest mean bond strength values (p < 0.05). The root perforations repair did not affect the bond strength of resin cement/customized fiberglass posts to bovine dentin. The increase in bond strength is luting protocol dependent.
... An experimental investigation evaluated the biocompatibility of a novel calcium aluminate cement (EndoBinder) in subcutaneous tissue of rats in comparison with calcium hydroxide hard-setting and cement mineral trioxide aggregate. The results showed that none of these materials had a significant effect on the levels of inflammatory cytokines over a threemonth period [123]. Recently, Sijari et al. also showed that in chronic periodontitis patients who used a sonic toothbrush after surgery in addition to 0.12% chlorhexidine (CHX) rinsing, GCF levels of IL-1β and IL-8 were decreased and in these patients wound healing was accelerated [124]. ...
Pulpitis is known as a typical inflammation of dental pulp tissue, and microorganisms of the oral microbiome are involved in this opportunistic infection. Studies indicated that several factors related to host response have a crucial role in pulpitis. Among these factors, inflammatory mediators of the immune system such as cytokines and chemokines contribute to pulpal defense mechanisms. A wide range of cytokines have been observed in dental pulp and these small molecules are able to trigger inflammation and participate in immune cell trafficking, cell proliferation, inflammation, and tissue damage in pulp space. Therefore, the aim of this review was to describe the role of cytokines in the pathogenesis of pulpitis.
... Total (4,7,8). In vitro and in vivo studies have previously shown its optimal physical/mechanical properties and favourable cellular response, allowing osteoblastic differentiation to be superior to that achieved with the use of MTA (4,9). However, other aspects of biocompatibility such as genotoxicity and hemocompatibility have not been reported for EB. ...
Objective: The aim of this in vitro study was to evaluate the genotoxicity and hemocompatibility of a novel calcium aluminate-based cement, EndoBinder (EB) ( Binderware, São Carlos, SP, Brazil) and compare it with Angelus White Mineral Trioxide Aggregate (MTA) (AWMTA) (Angelus, Soluções Odontológicas, Londrina, PR, Brazil).
Methods: For evaluation of genotoxicity, a comet assay was performed with Chinese hamster ovary (CHO) cells that had been grown for 24 h in Dulbecco’s Modified Eagle Medium incubated with each of the cements for 24 h at 37°C. DNA percentage in head and Olive tail moment were analyzed. For assessment of hemocompatibility, erythrocyte lysis quantification, and concentration of plasma fibrinogen were determined in human blood samples placed in contact with each of the materials. One way analysis of variance (ANOVA) followed by post hoc Tukey test and Student t-test were used for data analysis of genotoxicity and hemocompatibility, respectively. Results: Results showed that the genotoxic effects of EB and AWMTA were comparable to that of the negative control,
with no statistically significant differences between AWMTA and negative control (P>0.05). Compared to AWMTA, EB showed greater hemolytic potential when placed
in direct contact with erythrocytes (P<0.05).Fibrinogen values were low for both materials,
with protein concentration being greater in samples exposed to EB than to AWMTA.
Conclusion: Both materials presented a higher hemolytic behaviour compared to what is established by international standards. Fibrinogen formation was low for both materials, and DNA damage induction was not observed in a comet assay.
... Total (4,7,8). In vitro and in vivo studies have previously shown its optimal physical/mechanical properties and favourable cellular response, allowing osteoblastic differentiation to be superior to that achieved with the use of MTA (4,9). However, other aspects of biocompatibility such as genotoxicity and hemocompatibility have not been reported for EB. ...
Objective:
The aim of this in vitro study was to evaluate the genotoxicity and hemocompatibility of a novel calcium aluminate-based cement, EndoBinder (EB) (Binderware, São Carlos, SP, Brazil) and compare it with Angelus White Mineral Trioxide Aggregate (MTA) (AWMTA) (Angelus, Soluções Odontológicas, Londrina, PR, Brazil).
Methods:
For evaluation of genotoxicity, a comet assay was performed with Chinese hamster ovary (CHO) cells that had been grown for 24 h in Dulbecco's Modified Eagle Medium incubated with each of the cements for 24 h at 37°C. DNA percentage in head and Olive tail moment were analyzed. For assessment of hemocompatibility, erythrocyte lysis quantification, and concentration of plasma fibrinogen were determined in human blood samples placed in contact with each of the materials. One way analysis of variance (ANOVA) followed by post hoc Tukey test and Student t-test were used for data analysis of genotoxicity and hemocompatibility, respectively.
Results:
Results showed that the genotoxic effects of EB and AWMTA were comparable to that of the negative control, with no statistically significant differences between AWMTA and negative control (P>0.05). Compared to AWMTA, EB showed greater hemolytic potential when placed in direct contact with erythrocytes (P<0.05). Fibrinogen values were low for both materials, with protein concentration being greater in samples exposed to EB than to AWMTA.
Conclusion:
Both materials presented a higher hemolytic behaviour compared to what is established by international standards. Fibrinogen formation was low for both materials, and DNA damage induction was not observed in a comet assay.
... Moreover, the exposure of fibroblastic cells to CAC+ did not affect the expression levels of matrix metalloproteinase-2, an enzyme that plays an important role in the tissue changes that occur in chronic inflammation of the dental pulp and periapical tissues (Silva et al. 2012). In vivo, CAC+ elicited a reduced inflammatory reaction than MTA when implanted in rat subcutaneous tissue (Aguilar et al. 2012, Garcia et al. 2014. In bone defects of rat tibia, CAC+ exhibited similar behaviour to MTA, favouring complete bone repair at the end of 90 days (Garcia et al. 2015). ...
Aim:
To evaluate the effect of a calcium aluminate-based cement (CAC+) on the development of the osteogenic phenotype in vitro.
Methodology:
Rat calvaria-derived cells were grown on Thermanox(®) coverslips for 24 h and then exposed either to samples (4-hour set) of CAC+ or mineral trioxide aggregate (MTA) placed on Transwell(®) inserts for periods of up to 14 days. Non-exposed cultures were used as the controls. The comparisons were carried out using the non-parametric Kruskal-Wallis test, followed by the Student-Newman-Keuls post-hoc test when appropriate.
Results:
The results showed that proximity to MTA or CAC+ samples inhibited cell growth, whereas at a distance, viable and proliferative cells adhered to and spread on the Thermanox(®) , expressing osteoblast differentiation markers prior to mineralization of the extracellular matrix. Compared with MTA, the osteogenic cell cultures exposed to CAC+ exhibited significantly greater cell viability, alkaline phosphatase (ALP) activity and expression of runt-related transcription factor 2, osterix, ALP, bone sialoprotein and osteocalcin (p < 0.05 for all). For the osteogenic cell cultures exposed to CAC+, the quantification of matrix mineralization was not altered (p > 0.05).
Conclusions:
CAC+ supported the acquisition of the osteogenic cell phenotype in vitro, rendering this novel material a potential alternative to MTA in endodontic procedures. Further in vivo studies are needed to verify if the beneficial in vitro effects of CAC+ on osteoblastic cells correspond to an increase and/or acceleration of bone repair in the periapical region. This article is protected by copyright. All rights reserved.
... Impurities such as Fe 2 O 3 and MgO were reduced to minimize the potential for tooth darkening and undesirable water-induced expansion. Marketed as EndoBinder (Binerware, São Carlos, SP, Brazil) 15 , the calcium aluminate cement has been advocated as an alternative to calcium silicate endodontic cements based on its biocompatibility 15 , minimal stimulation of inflammatory reactions in animal studies 16 , as well as its ability to promote repair of mineralized tissues in cell culture studies 17 . ...
Discoloration-resistant calcium aluminosilicate cement has been formulated to overcome the timely problem of tooth discoloration reported in the clinical application of bismuth oxide-containing hydraulic cements. The present study examined the effects of this experimental cement (Quick-Set2) on the viability and proliferation of human dental pulp stem cells (hDPSCs) by comparing the cellular responses with commercially available calcium silicate cement (white mineral trioxide aggregate; WMTA) after different aging periods. Cell viability and proliferation were examined using assays that examined plasma membrane integrity, leakage of cytosolic enzyme, caspase-3 activity for early apoptosis, oxidative stress, mitochondrial metabolic activity and intracellular DNA content. Results of the six assays indicated that both Quick-Set2 and WMTA were initially cytotoxic to hDPSCs after setting for 24 h, with Quick-Set2 being comparatively less cytotoxic than WMTA at this stage. After two aging cycles, the cytotoxicity profiles of the two hydraulic cements were not significantly different and were much less cytotoxic than the positive control (zinc oxide–eugenol cement). Based on these results, it is envisaged that any potential beneficial effect of the discoloration-resistant calcium aluminosilicate cement on osteogenesis by differentiated hDPSCs is more likely to be revealed after outward diffusion and removal of its cytotoxic components.
... Impurities such as Fe 2 O 3 and MgO were reduced to minimize the potential for tooth darkening and undesirable water-induced expansion. Marketed as EndoBinder (Binerware, São Carlos, SP, Brazil) 15 , the calcium aluminate cement has been advocated as an alternative to calcium silicate endodontic cements based on its biocompatibility 15 , minimal stimulation of inflammatory reactions in animal studies 16 , as well as its ability to promote repair of mineralized tissues in cell culture studies 17 . ...
Objectives:
In pulpal revascularization, a protective material is placed coronal to the blood clot to prevent recontamination and to facilitate osteogenic differentiation of mesenchymal stem cells to produce new dental tissues. Although mineral trioxide aggregate (MTA) has been the material of choice for clot protection, it is easily displaced into the clot during condensation. The present study evaluated the effects of recently introduced calcium silicate cements (Biodentine and TheraCal LC) on the viability and osteogenic differentiation of human dental pulp stem cells (hDPSCs) by comparing with MTA Angelus.
Methods:
Cell viability was assessed using XTT assay and flow cytometry. The osteogenic potential of hDPSCs exposed to calcium silicate cements was examined using qRT-PCR for osteogenic gene expressions, alkaline phosphatase enzyme activity, Alizarin red S staining and transmission electron microscopy of extracellular calcium deposits. Parametric statistical methods were employed for analyses of significant difference among groups, with α=0.05.
Results:
The cytotoxic effects of Biodentine and TheraCal LC on hDPSCs were time- and concentration-dependent. Osteogenic differentiation of hDPSCs was enhanced after exposure to Biodentine that was depleted of its cytotoxic components. This effect was less readily observed in hDPSCs exposed to TheraCal LC, although both cements supported extracellular mineralization better than the positive control (zinc oxide-eugenol-based cement).
Significance:
A favorable tissue response is anticipated to occur with the use of Biodentine as a blood clot-protecting material for pulpal revascularization. Further investigations with the use of in vivo animal models are required to validate the potential adverse biological effects of TheraCal LC on hDPSCs.
... Highly organized dentinogenesis; greater than 75% up to 100% normal tubular dentin formation Basic Research-Biology could reduce or slow the precipitation of hydroxyapatite and overall healing. Another calcium monoaluminate-based material (EndoBinder; Binderware, São Carlos, SP, Brazil) has been shown to have a lower pH than MTA but produced only a limited inflammatory reaction in a subcutaneous test (28). For some groups examined here, the standard deviations were relatively large, indicating variability between the scored teeth. ...
Quick-Set (Primus Consulting, Bradenton, FL) is a calcium aluminosilicate cement that is a potential alternative to mineral trioxide aggregate (MTA) with greater acid resistance and faster setting. The purpose of this study was to compare the effects of Quick-Set and MTA on pulpal tissues in response to pulpotomy procedures.
The pulp chambers of 42 maxillary teeth in 7 beagle dogs were accessed, and the coronal pulpal tissue was removed. Pulpotomy procedures were performed, placing the experimental materials directly over the radicular pulp tissues. The dogs were sacrificed at 70 days, and the teeth and surrounding tissues were removed and prepared for histologic analysis. The sections of the pulpotomy areas were scored for inflammation, pulp tissue organization, reactionary dentin formation, and quality of dentinogenesis.
The Quick-Set group exhibited significantly more pulpal inflammation (P = .002) and significantly less pulp tissue organization (P = .004). No significant difference was noted for reactionary dentin formation (P = .526) and quality of dentinogenesis (P = .436).
Compared with ProRoot White MTA (Dentsply Tulsa Dental Specialties, Tulsa, OK), Quick-Set exhibited more pulpal inflammation and decreased pulp tissue organization. No significant differences were noted for reactionary dentin formation and quality of dentinogenesis.
Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
The aim of this study was to evaluate the biocompatibility and immunoinflammatory response of the Sealepox and Sealepox-RP, based on interleukin (IL)-6, tumor necrosis factor (TNF)-α, and CD5 immunolabelling. The ProRoot MTA (PRMTA) was used for comparison. Polyethylene tubes (1.0-mm internal, 1.6-mm external diameter, and 10.0-mm length; ISO 10993) with or without (control) materials were randomly implanted in the dorsum of 35 rats (4 per rat). After 7, 15, 30, 60, and 90 days (n = 7), the tubes were removed for histological and immunohistochemical analysis. The Kruskal–Wallis and Dunn’s test for non-parametric data and, ANOVA and Tukey test for parametric data were used (P < 0.05). Hematoxylin and eosin staining revealed that the concentration of inflammatory cells decreased over time with no differences between groups in all periods (P > 0.05). Regarding IL-6 immunostaining, there was no difference at 7 days (P > 0.05); all groups decreased over time, being faster for the PRMTA group and also, with no differences between groups in the last period (P > 0.05). For TNF-α, at 7 days there was no difference between groups (P > 0.05); there was an increase at 15 days for PRMTA and, at 30 and 60 days, for PRMTA and Sealepox compared to the control (P < 0.05). At 90 days, Sealepox RP showed the lowest immunostaining being similar to the control (P > 0.05). Regarding CD5 cells, at 7 days, there was high immunostaining for PRMTA compared to the control (P < 0.05); and significant reduction over time with difference for all groups at 30 and 60 days. (P < 0.05); Sealepox was similar to the control in all periods (P > 0.05). Sealepox RP showed the highest immunostaining at 15 days, being different from the control and PRMTA (P < 0.05); in the other periods it was similar to the control (P > 0.05). It can be concluded that Sealepox and Sealepox-RP were biocompatible and demonstrated similar immunoinflammatory response regarding IL-6, TNF-α, and CD5 compared to PRMTA.
This study assessed the fracture resistance of simulated immature teeth reinforced with calcium aluminate cement (CAC) or mineral trioxide aggregate (MTA) containing calcium carbonate nanoparticles (nano-CaCO3). The microstructural arrangement of the cements and their chemical constitution were also evaluated. Forty-eight canines simulating immature teeth were distributed into 6 groups (n=8): Negative control - no apical plug or root canal filling; CAC - apical plug with CAC; CAC/nano-CaCO3 - apical plug with CAC+5% nano-CaCO3; MTA - apical plug with MTA; MTA/nano-CaCO3 - apical plug with MTA+5% nano-CaCO3; and Positive control - root canal filling with MTA. The fracture resistance was evaluated in a universal testing machine. Samples of the cements were analyzed under Scanning Electron Microscope (SEM) to determine their microstructural arrangement. Chemical analysis of the cements was performed by Energy Dispersive X-ray Spectroscopy (EDS). The fracture resistance of CAC/nano-CaCO3 was significantly higher than the negative control (p<0.05). There was no significant difference among the other groups (p>0.05). Both cements had a more regular microstructure with the addition of nano-CaCO3. MTA samples had more calcium available in soluble forms than CAC. The addition of nano-CaCO3 to CAC increased the fracture resistance of teeth in comparison with the non-reinforced teeth. The microstructure of both cements containing nano-CaCO3 was similar, with a more homogeneous distribution of lamellar- and prismatic-shaped crystals. MTA had more calcium available in soluble forms than CAC.
Objectives:
This study compared the cytotoxicity, biocompatibility, and tenascin immunolabeling of a new ready-to-use hydraulic sealer (Bio-C Sealer) with MTA-Fillapex and white MTA-Angelus.
Materials and methods:
L929 fibroblasts were cultivated and exposed to undiluted and diluted material extracts. Polyethylene tubes with or without (the control) the materials were implanted into the dorsa of rats. At 7 days and 30 days, the rats were euthanized, and the specimens were prepared for analysis; inflammation and immunolabeling were measured, and statistical analysis was performed (p < 0.05).
Results:
MTA-Fillapex exhibited greater cytotoxicity than the other materials at all time points (p < 0.05). The undiluted Bio-C Sealer exhibited greater cytocompatibility at 6 and 48 hours than white MTA-Angelus, with higher cell viability than in the control (p < 0.05). White MTA-Angelus displayed higher cell viability than the control at 24 hours, and the one-half dilution displayed similar results at both 6 and 48 hours (p < 0.05). At 7 days and 30 days, the groups exhibited moderate inflammation with thick fibrous capsules and mild inflammation with thin fibrous capsules, respectively (p > 0.05). At 7 days, moderate to strong immunolabeling was observed (p > 0.05). After 30 days, the control and MTA-Fillapex groups exhibited strong immunolabeling, the white MTA-Angelus group exhibited moderate immunolabeling (p > 0.05), and the Bio-C Sealer group exhibited low-to-moderate immunolabeling, differing significantly from the control (p < 0.05).
Conclusions:
Bio-C Sealer and white MTA-Angelus exhibited greater cytocompatibility than MTA-Fillapex; all materials displayed adequate biocompatibility and induced tenascin immunolabeling.
Failure of root canal therapy may be treated surgically or by revising treatment. There is some evidence to suggest that surgical management of failed cases has a higher success rate than the conservative nonsurgical approach in the short term. Materials used for apical surgery, as well as those that seal off perforations, block the root canal and its contents from the surrounding bone and periodontium. These must possess certain characteristics that allow them to perform well in a very specific environment. Various types of materials, mostly used for conservative dentistry, have been employed for corrective and apical surgery, with adequate success rates. Hydraulic calcium silicate cements (HCSCs) were developed specifically for these procedures. Their main characteristic is the presence of calcium hydroxide, which raises their pH and allows ready release of calcium, providing antimicrobial and biological properties. That they are hydraulic enables them to perform well in the wet environment of the surgical field. This chapter reviews mechanical, chemical, biological, and antimicrobial properties, clinical techniques, environmental interactions, and clinical evaluations for each material type. Although considerable success has been shown with conventional materials, particularly those that are zinc oxide‐eugenol (ZOE)‐based, HCSC in combination with microsurgical techniques has improved the success rate of endodontic surgical procedures. These materials continue to be developed. In the future, a better understanding of the ideal material requirements, combined with an appropriate clinical protocol, may lead to more predictable surgical outcomes.
Background
This study evaluated the marginal adaptation, solubility and biocompatibility of TheraCal LC compared with mineral trioxide aggregate (MTA-Angelus) and Biodentine when used as a furcation perforation repair material.
Methods
The marginal adaptation was assessed by scanning electronic microscope and presence of any gap between the dentin surface and filling material in each quadrant of the sample was analyzed at 1000 X magnification. The solubility was measured after one week by the ISO standard method. Biocompatibility was evaluated by the inflammatory response and radiography after one month and three months of repair of experimental furcation perforations in dog's teeth.
Results
There were significant differences in the marginal adaptation, solubility and biocompatibility of the tested materials (P < 0.05). TheraCal LC showed the highest frequency distribution of gap presence that was followed by the MTA-Angelus then Biodentine. The least soluble material after one week was TheraCal LC that was followed by the MTA-Angelus and Biodentine. After one month and three months, TheraCal LC showed the highest inflammatory response and highest frequency distribution of radiolucency that was followed by the Biodentine then MTA-Angelus.
Conclusion
Unlike Biodentine, TheraCal LC is incapable of alternating the MTA in furcation perforation repair due to its poor biocompatibility and poor marginal adaptation.
This study evaluated the biocompatibility, biomineralization, and collagen fiber maturation induced by Resorbable Tissue Replacement (RTR®; β-tricalcium phosphate [TCP]), Bioglass (BIOG; bioactive glass), and DM Bone® (DMB; hydroxyapatite and β-TCP) in vivo. Sixty-four polyethylene tubes with or without (control group; CG) materials (n=8/group/period) were randomly implanted in the subcutaneous tissue of 16 male Wistar rats (four per rat), weighting 250 to 280 g. The rats were killed after 7 and 30 days (n=8), and the specimens were removed for analysis of inflammation using hematoxylin-eosin; biomineralization assay using von Kossa (VK) staining and polarized light (PL); and collagen fiber maturation using picrosirius red (PSR). Nonparametric data were statistically analyzed by Kruskal-Wallis and Dunn tests, and parametric data by one-way ANOVA test (p<0.05). At 7 days, all groups induced moderate inflammation (p>0.05). At 30 days, there was mild inflammation in the BIOG and CG, and moderate inflammation in the RTR and DMB groups, with a significant difference between the CG and RTR (p<0.05). The fibrous capsule was thick at 7 days and predominantly thin at 30 days in all groups. All materials exhibited structures that stained positively for VK and PL. Immature collagen fibers were predominant at 7 and 30 days in all groups (p>0.05), although DMB exhibited more mature fibers than BIOG at 30 days (p<0.05). RTR, BIOG, and DMB were biocompatible, inducing inflammation that reduced over time and biomineralization in the subcutaneous tissue of rats. DMB exhibited more mature collagen fibers than BIOG over a longer period.
Background
The purpose of this study was to compare the biocompatibility of three bioactive materials, namely ACTIVA bioactive restorative resin composite, iRoot BP plus and Mineral Trioxide Aggregate (MTA) Angelus-HP.
Methods
Seventy-five Wistar male rats were subjected to subcutaneous implantation of four polyethylene tubes; one empty tube was used as control (Group 1), and the other tubes were filled with ACTIVA (Group 2), iRoot BP (Group 3) and MTA-HP (Group 4). Then, the rats were subdivided into 3 groups according to the sacrification time into one, two and 4 weeks (n = 25 rats). Tissue specimens were submitted to histopathological and immunohistochemical analysis of α-SMA and caspase 3.
Results
The one-way Anova test revealed that ACTIVA group exhibited minimal inflammation in comparison to calcium silicate cements (iRoot BP and MTA-HP groups). iRoot BP group significantly revealed a more severe degree of chronic inflammation in comparison to other groups (P < 0.05). ACTIVA group showed marked regression of inflammation and fibrosis comparable to the control, while iRoot BP group revealed remarkable fibrosis and calcification, with less degrees in MTA-HP group (P < 0.05). Immunostaining of both α-SMA and caspase 3 revealed lower indexes in ACTIVA group consistent with the control (P < 0.05).
Conclusions
ACTIVA showed a higher degree of biocompatibility to subcutaneous tissues in comparison to both iRoot BP and MTA-HP cements in regard to decrease the intensity of inflammation, with subsequent fibrous connective tissue remodeling and better healing patterns.
Clinical significance
Preliminary data suggests that the application of ACTIVA in retrograde fillings.
Aim
To examine the potential systemic toxicity of nanostructured materials based on calcium silicate and calcium aluminate, for potential application in Dentistry.
Methodology
Twenty four Albino Wistar rats aged two months were used as an in vivo animal model for subcutaneous implantation of the investigated materials, placed in polyethylene tubes. Thirty days after implantation, the livers of the rats were analyzed and following histological and stereological parameters were evaluated for: volume density of hepatocytes and blood sinusoids, number and numerical density of hepatocytes, surface of hepatocytes and their nucleuses, nucleocytoplasmic ratio and mitotic index of hepatocytes. Stereological measurements were achieved using Cavalieri's principle, with grid P2 and unbiased analysis. Additionally, immunohistochemistry studies were performed to further analyze changes in liver tissue. Several haematological and biochemical parameters of blood of experimental animals were also analyzed, as well as local tissue reactions around the implants. Statistical analysis was performed using parametric (ANOVA and t test) and non‐parametric tests (Kruskal‐Wallis and Mann‐Whitney U test) depending on data distribution.
Results
.Implanted dental cements led to an increase in stereological and histological parameters in liver tissue compared to control rats. Although the investigated parameters mostly showed significant differences between control and experimental animals, the liver tissue of the experimental animals did not have visible signs of pathological changes. This was supported by the analysis of blood parameters which were not significantly different between control and experimental animals. Also, the subcutaneous tissues had minimal inflammatory reactions. Immunohistochemistry studies revealed that nanostructured materials induced proliferation of hepatocytes, but that the immunological response to the materials was not strong enough to induce proliferation of immunoreactive cells in liver in the observed time period.
Conclusions
This study was performed as a contribution to the attestation of the biocompatibility of dental cements based on calcium silicate and calcium aluminate. Although these materials induced several changes in the liver structure, they were not clinically relevant and represent a normal and reversible response of the liver to the presence of biocompatible materials in the body. Blood and immunohistochemistry analyses and local tissue reactions further confirmed that these materials possess good biocompatible potential.
This article is protected by copyright. All rights reserved.
Objective
Several studies reported the local tissue reaction caused by mineral aggregate-based cements. However, few studies have investigated the systemic effects promoted by these cements on liver and kidney when directly applied to connective tissue. The purpose of this in vivo study was to investigate the systemic effect of mineral aggregate-based cements on the livers and kidneys of rats.
Material and Methods
Samples of Mineral Trioxide Aggregate (MTA) and a calcium aluminate-based cement (EndoBinder) containing different radiopacifiers were implanted into the dorsum of 40 rats. After 7 and 30 d, samples of subcutaneous, liver and kidney tissues were submitted to histopathological analysis. A score (0-3) was used to grade the inflammatory reaction. Blood samples were collected to evaluate changes in hepatic and renal functions of animals.
Results
The moderate inflammatory reaction (2) observed for 7 d in the subcutaneous tissue decreased with time for all cements. The thickness of inflammatory capsules also presented a significant decrease with time (P<.05). Systemically, all cements caused adverse inflammatory reactions in the liver and kidney, being more evident for MTA, persisting until the end of the analysis. Liver functions increased significantly for MTA during 30 d (P<.05).
Conclusion
The different cements induced to a locally limited inflammatory reaction. However, from the systemic point of view, the cements promoted significant inflammatory reactions in the liver and kidney. For MTA, the reactions were more accentuated.
The aim of this study was to evaluate the injurious effects of mineral trioxide Aggregate (MTA) and EndoSequence Bioceramic Root Repair Material (ERRM; Brassler USA, Savannah, GA) 7 and 30 days after their implantation into rat subcutaneous tissues.
Twelve Wistar rats were selected for the present study. Each animal received 3 implants: one contained MTA, one contained ERRM, and one was an empty tube that served as a control. Half of the animals were killed after 7 days, and the remaining animals were killed 30 days after implantation. Histologic sections prepared from the skin specimens were stained with H&E, toluidine blue, Masson trichrome, and Congo red. The data were statistically analyzed with 1-way analysis of variance and paired t tests. The P value for significance was set at .05.
After 7 days, MTA produced a significantly greater inflammatory reaction that involved the deposition of amyloidlike protein and an increase in the mast cell population compared with ERRM (P < .05). After 30 days, the ERRM group exhibited significantly reduced inflammatory reactions compared to the MTA groups (P < .05). Areas of mononuclear cell aggregation, abscess formation, and necrosis were observed more frequently in the MTA group. The thickness of the fibrous capsule was significantly increased in the MTA compared with the ERRM groups (P < .05). Amyloidlike proteins were more frequently observed around the fibrous capsule and subdermal blood vessels and were more frequently deposited in the MTA than the ERRM specimens.
The findings of the present study suggest that both ERRM and MTA cause an injurious effect when implanted in rat subcutaneous tissues after 7 and 30 days. ERRM is significantly less injurious to tissues than MTA.
Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
The aim of this study was to evaluate the solubility and disintegration of EndoBinder (EB) containing 3 different radiopacifying agents, bismuth oxide (Bi2O3), zinc oxide (ZnO), or zirconium oxide (ZrO2), in comparison with gray mineral trioxide aggregate (GMTA) and white MTA (WMTA).
Ten specimens of each cement were made in a stainless steel matrix (20 × 1.5 mm) according to Specification no. 57 of American National Standards Institute/American Dental Association: EB + Bi2O3, EB + ZrO, EB + ZnO, WMTA, and GMTA. The specimens were weighed on an accurate analytical scale and immersed in 50 mL distilled and deionized water at 37°C for 7 days. Afterwards, specimens were dried and weighed again to determine mass loss (%). Resulting solutions were analyzed in an atomic absorption spectrophotometer for identification and quantification of chemical elements released.
All cements presented mean values of solubility and disintegration above the American National Standards Institute/American Dental Association Specification no. 57. EB + Bi2O3 presented the lowest mass loss (5.08%) and WMTA (6.65%) the highest, with no statistically significant difference (P > .05). The release of several chemical elements was observed, mostly metal ions. Only GMTA and EB + Bi2O3 showed the presence of Cr, with significant difference (P < .05). EB + ZnO presented the highest levels of Pb, followed by WMTA (P < .05). For As, the cements presented different release levels, with EB + ZnO showing the highest and GMTA the lowest levels (P < .05). However, the amounts of As and Pb released were lower than the safe limit proposed by ISO 9917-1.
Irrespective of the radiopacifying agents used, EndoBinder presented similar behavior to MTA.
Aim:
To evaluate the staining susceptibility of new calcium aluminate cement (EndoBinder, EB) in teeth, with or without radiopacifying agent, in comparison with mineral trioxide aggregate (MTA).
Materials and methods:
Forty bovine incisors were used. After biomechanical preparation and filling, 2 mm of their fillings were removed for cervical plug fabrication (n = 10): EB without radiopacifier; EndoBinder + Bismuth Oxide (EBBO); Gray mineral trioxide aggregate (GMTA) and White mineral trioxide aggregate (WMTA). After teeth restoration, initial color readout was taken (Easyshade - CIE Lab) on the vestibular face. The teeth were stored in artificial saliva at 37°C for 1 year, and after time intervals of 30, 180, and 360 days, new color readouts were taken to determine color alteration (ΔE) in comparison with the initial readout (baseline).
Results:
The results (2-way anova repeated measures, Bonferroni - P < 0.05) demonstrated that after 360 days, all groups presented ΔE above the clinically accepted limit (ΔE ≥ 3.3), however, without significant difference among them (P > 0.05). All groups presented decrease in ΔL values over the course of time, and the greatest variation occurred for WMTA, with significant difference in comparison with EB and EBBO (P < 0.05).
Conclusions:
Some negative features of MTA, such as the high incidence of dental structures staining justify the development of new materials. GMTA, WMTA, and EB with and without radiopacifying agent displayed color alteration (ΔE) after 360 days; however, the luminosity change (ΔL) was lower in EB in comparison with GMTA and WMTA.
To assess the effectiveness of mineral trioxide aggregate (MTA) used as an indirect pulp-capping material in human molar and premolar teeth.
We conducted a clinical evaluation of 60 teeth, which underwent an indirect pulp-capping procedure with either MTA or calcium hydroxide cement (Dycal(®) ). Calcium hydroxide was compared with MTA and the thickness of the newly formed dentine was measured at regular time intervals. The follow-up was at 3 and 6 months, and dentine formation was monitored by radiological measurements on digitised images using Mesurim Pro(®) software.
At 3 months, the clinical success rates of MTA and calcium hydroxide were 93% and 73%, respectively (P = 0.02). At 6 months, the success rate was 89.6% with MTA, and remained steady at 73% with calcium hydroxide (P = 0.63). The mean initial residual dentine thickness was 0.23 mm, and increased by 0.121 mm with MTA and by 0.136 mm with calcium hydroxide at 3 months. At 6 months, there was an increase of 0.235 mm with MTA and of 0.221 mm with calcium hydroxide.
A higher success rate was observed in the MTA group relative to the Dycal(®) group after 3 months, which was statistically significant. After 6 months, no statistically significant difference was found in the dentine thickness between the two groups. Additional histological investigations are needed to support these findings.
This study used dye leakage assay and scanning electron microscopy to evaluate, respectively, the sealing ability and marginal adaptation of three root-end filling materials used as apical plugs, as well as the possible correlation between these properties.
Ninety-eight single-rooted human teeth were prepared to simulate an open apex. The teeth were allocated to three experimental groups (n = 30), which received a 5-mm thick apical plug of (1) gray MTA Angelus, (2) CPM and (3) MBPc, and two controls groups (n = 4). After immersion in 0.2% Rhodamine B solution for 48 h, the teeth were sectioned longitudinally and analyzed by Image Tool 3.0 software. The marginal adaptation between apical plugs and the root canal walls were analyzed by SEM.
MBPc had significantly less (p<0.05) apical leakage than the other materials. Regarding marginal adaptation, CPM showed the best numerical results, though without statistical significance from the other materials (p<0.05). There was no correlation between the two properties.
When used as apical plugs, the tested root-end filling materials had similar marginal adaptation to the dentin walls, but MBPc had the best sealing ability, as demonstrated by the least apical leakage from all tested materials.
Several studies reported superior healing results for ProRoot mineral trioxide aggregate (MTA; Dentsply Tulsa) cement in direct pulp capping when compared to calcium hydroxide. However, this could not be confirmed by other authors. The aim of this study was to compare the reaction of MTA-treated rat pulp tissue to calcium hydroxide [Ca(OH)2]-treated rat pulp tissue in direct pulp capping after 1 to 70 days.
Seventy-two caries- free, maxillary right and left first molars of 36 Wistar rats were prepared with an occlusal cavity. The pulp chambers were then perforated with a sharp probe. For each of four time periods, MTA was placed on the exposed pulp of 10 molars according to the manufacturer's instructions, and Ca(OH)2 was placed on 8 molars. All cavities were then filled with dentin adhesive and flowable composite. The animals were sacrificed 1, 3, 7, and 70 days after pulp capping. The pulps were histologically analyzed (light and transmission electron microscopic) for bacterial infection, inflammatory cells, necrosis, and reparative dentin and classified according to occurrence in scores from 1 to 4. To ensure that the coronal restorations did not leak, occlusal cavities were prepared in four maxillary molars of one rat. The coronal cavity was then sealed with resin. After 70 days, the rat was sacrificed, and the molars were immersed in new fuchsin. Data were statistically evaluated with the Kruskal-Wallis test (P<.05).
The MTA group showed statistically significantly lower signs of necrosis 1 and 3 days after pulp capping when compared with the Ca(OH)2 group (P<.05). No other statistically significant differences were found (P>.05). After 70 days, all pulps displayed healthy tissue. In the leakage test no specimens revealed any dye penetration.
MTA showed equally good results as Ca(OH)2 and can berecommended clinically for direct pulp capping.
The purpose of this study was to evaluate the subcutaneous connective tissue reactions to ProRoot, mineral trioxide aggregate (MTA; Dentsply), and Oralloy, high-copper amalgam (Coltene). These materials were placed in polyethylene tubes and implanted into dorsal connective tissue of Wistar albino rats, and tissue biopsies were collected and histologically examined 7, 15, 30, 60, and 90 days after the implantation procedure. The presence of inflammation, predominant cell type, calcification, and thickness of fibrous connective tissue were recorded. Scores were defined as follows: 0, none or few inflammatory cells, no reaction; 1, < 25 cells, mild reaction; 2, 25 to 125 cells, moderate reaction; 3, > or = 125 cells, severe reaction. Fibrous capsule was categorized as "thin" when thickness was < 150 microm and "thick" at > 150 microm. Necrosis and formation of calcification were recorded. Both materials were well tolerated by the tissues in a 90-day evaluation period. One notable finding is the presence of dystrophic calcification in connective tissue adjacent to MTA; this finding is consistent with the hypothesis of hard tissue induction by this material.
To assess the outcome of apexification using mineral trioxide aggregate (MTA).
Fifty-seven teeth with open apices on 50 patients referred for root canal treatment received an apexification procedure in one appointment with MTA by the same operator. Patients were recalled at 6 months, 12 months and every year thereafter. Blind to the treatment record, two examiners assessed the pre-treatment, post-treatment and control radiographs of the study patients in a dark room using a magnifier. Each apex visible on the radiographs was scored with the periapical index (PAI), and the size of the apical lesion was measured. The presence of an apical bridge was also noted. Kappa-Cohen test was used for examiners calibration. The paired t-test was used for statistical analysis of apical healing.
Forty-three cases were included with at least 12 months follow-up. When considering the PAI score and the decrease in size of the apical lesion, healing occurred in 81% of cases.
Apexification in one step using an apical plug of MTA can be considered a predictable treatment, and may be an alternative to the use of calcium hydroxide.
The purpose of this study was to investigate the diffusion of calcium ions (Ca+2) through exposed dentinal tubules following intracanal application of mineral trioxide aggregate (MTA). Fifty-two single-rooted teeth were instrumented using 2.5% sodium hypochlorite for irrigation between each file size. Thereafter, standardized defects were created on the root surfaces so as to mimic external root resorption. The root canals and external defects received a final irrigation of 17% ethylenediaminetetraacetic acid and distilled water. MTA powder was then mixed with saline and placed into the canals. All root surfaces except the cavities were sealed with two coats of varnish. Teeth with unfilled canals (n = 26) served as controls. The teeth were immersed in saline after which the release of Ca+2 from the defects into the saline was measured at 1, 3, 7, 14, and 28 days. The results showed diffusion of Ca+2 through the defects in the dentin in MTA-filled roots with a significant increase in concentration within time.
IntroductionThe purpose of this study was to evaluate the biocompatibility of calcium aluminate cement (EndoBinder) in subcutaneous tissue of rats.Methods
Fifteen rats, weighing 300 g, were separated into 3 groups (n = 5) in accordance with the time of death (7, 21, 42 days). Two incisions were made in the dorsal subcutaneous tissue of each rat in which were implanted 2 polyethylene tubes filled with the test materials, EndoBinder (EB) and Grey MTA (GMTA). The external tube walls were considered the negative control group (CG). After 7, 21, and 42 days, animals were killed, obtaining 5 samples per group, at each time interval of analysis.ResultsFrom the morphologic and morphometric analyses by using a score of (0–3) (50, 100, and 400×), results showed absence of inflammatory reaction (0) for EB after 42 days. However, for GMTA, a slight inflammatory reaction (1) was observed after 42 days, which means the persistence of a chronic inflammatory process. When compared with CG, tissue reaction ranging from discrete (1–7 days) to absent (0–42 days) was observed.Conclusions
EndoBinder presented satisfactory tissue reaction; it was biocompatible when tested in subcutaneous tissue of rats.
The purpose of this study was a long-term comparison of the dimensional changes of endodontic sealers of diverse properties. The sealers were injected as thin layers on the internal walls of glass pipettes 1 mm in diameter. The pipettes were filled with deionized water, and the water meniscus levels were recorded periodically up to 180 days. The water was removed from the pipettes, samples were allowed to dry, and the mass and the volume of the sealers were measured. AH26 and Endo-Fill had an initial expansion followed by a volumetric loss. The two zinc oxide eugenol-based sealers studied started to shrink within hours after mixing; the first volumetric loss for AH26 was recorded during the first 30 days and for Endo-Fill after 30 days. The least dimensional change at any time was observed for Endo-Fill. It was concluded that a significant dimensional change and continued volume loss can occur in some endodontic sealers.
To compare the histological pulp reaction to various water/powder ratios of white mineral trioxide aggregate (MTA) as a pulp-capping material in healthy human teeth.
Twenty-nine disease-free maxillary and mandibular third molar teeth, scheduled for extraction, were exposed mechanically and then capped with 0.28, 0.33 and 0.40 water/powder ratios of white MTA (ProRoot; Dentsply Maillefer, Ballaigues, Switzerland) and restored with glass ionomer. After 30 days, the teeth were extracted, resected apically and immersed in 10% formalin. For histological processing, the teeth were sectioned buccolingually in 5-μm-thick slices, stained with Haematoxylin and Eosin and evaluated by a light microscope. Samples were evaluated for intensity and type of inflammation, presence of necrosis, as well as continuity, morphology and thickness of calcified bridges. The data were analysed by Kruskal-Wallis and Mann-Whitney tests.
There were no significant differences in the diameter, morphology and continuity of the calcified bridges, intensity and type of inflammation or presence of necrosis (P > 0.05) in the pulps covered by MTA with various water/powder ratios. Two teeth failed to display a calcified bridge, and one had a pulp necrosis.
Water-to-powder ratios of MTA had no significant influence on the histological outcome of direct pulp capping on healthy pulps.
Portland cement is used in the construction industry as a binder in concrete. It is manufactured from chalk, limestone, and clay, which are clinkered at very high temperatures and ground with gypsum to form Portland cement. The raw materials and the manufacturing process can result in the inclusion of heavy metals in Portland cement. Portland cement with a four to one addition of bismuth oxide is marketed as mineral trioxide aggregate (MTA), which is used mainly as a dental material. Heavy metal inclusion can be of concern because MTA is in contact with hard and soft tissues.
Measurements of arsenic, lead, and chromium in hydrated gray and white Portland cement, ProRoot MTA, and MTA Angelus were conducted with graphite furnace atomic absorption spectrophotometry after acid digestion on the hydrated material. The leaching of the metal ions from the solid material in water and simulated body fluid (SBF) was also determined.
All cement types showed high relative values of leached chromium compared with arsenic and lead in both the total metal content and leached species. The gray Portland cement showed the highest total amount of metal. The white Portland and both MTAs had lower values for all the leached metal ions.
Both MTAs released more arsenic than the amount specified in ISO 9917-1 (2007). Portland cements and MTAs showed evidence of heavy metals in the acid-soluble form as well as leaching in deionized water and SBF. MTA contained levels of arsenic higher than the safe limit specified by the ISO 9917-1 (2007).
The aim was to evaluate the proliferation of pulp cells 1, 3, and 7 days after direct pulp capping with ProRoot MTA (MTA) and to compare the results with calcium hydroxide (Ca(OH)(2)).
An occlusal cavity was prepared in 36 molar teeth of 18 Wistar rats. Then MTA or Ca(OH)(2) was placed on the exposed pulp. All cavities were restored with composite. After 1, 3, and 7 days the animals were killed. One hour before scarification 5-bromo-2'-deoxyuridine (BrdU) was injected into the intraperitoneal cavity for immunohistologic analysis. BrdU was incorporated into the cell nucleus during the S phase of the cell cycle. Proliferating cells were tagged and counted by using alkaline phosphatase and anti-alkaline phosphatase antibody staining. Three animals (6 molar teeth) served as controls and were not further treated. The number of the tagged cells was statistically analyzed by comparing the results of the 3 groups. A Bonferroni correction was performed, because the data of the Ca(OH)(2)- group was used 3 times for pairwise comparison.
The marked cells were identified as fibroblasts, endothelial cells (after 1, 3, and 7 days), and Höhl cells (after 7 days). The MTA group showed a similar amount of Höhl cells when compared with the Ca(OH)(2) group (P > .05). One day and 7 days after capping, no significant differences were observed between the 2 tested groups and the controls (P > .05). After 3 days, significantly more cells were stained in the MTA and Ca(OH)(2) groups than in the control group (P < .016).
Immunohistologic analysis demonstrated that MTA showed similar results when compared with Ca(OH)(2) within the first week after direct pulp capping.
Mineral trioxide aggregate (MTA) was developed because existing materials did not have the ideal characteristics for orthograde or retrograde root-end fillings. MTA has been recommended primarily as a root-end filling material, but it has also been used in pulp capping, pulpotomy, apical barrier formation in teeth with open apexes, repair of root perforations, and root canal filling. Part I of this literature review presented a comprehensive list of articles regarding the chemical and physical properties as well as the antibacterial activity of MTA. The purpose of part II of this review is to present a comprehensive list of articles regarding the sealing ability and biocompatibility of this material.
A review of the literature was performed by using electronic and hand-searching methods for the sealing ability and biocompatibility of MTA from November 1993-September 2009.
Numerous studies have investigated the sealing ability and biocompatibility of MTA.
On the basis of available evidence it appears that MTA seals well and is a biocompatible material.
An ideal orthograde or retrograde filling material should seal the pathways of communication between the root canal system and its surrounding tissues. It should also be nontoxic, noncarcinogenic, nongenotoxic, biocompatible, insoluble in tissue fluids, and dimensionally stable. Mineral trioxide aggregate (MTA) was developed and recommended initially because existing root-end filling materials did not have these "ideal" characteristics. MTA has also been recommended for pulp capping, pulpotomy, apical barrier formation in teeth with open apexes, repair of root perforations, and root canal filling. Since MTA's introduction in 1993, numerous studies have been published regarding various aspects of this material. The aim of Part I of this literature review is to present investigations regarding the chemical, physical, and antibacterial properties of MTA.
A review of the literature was performed by using electronic and hand-searching methods for the chemical and physical properties and antibacterial activity of MTA from November 1993-September 2009.
There are many published reports regarding the chemical, physical, and antibacterial properties of MTA. Our search showed that MTA is composed of calcium, silica, and bismuth. It has a long setting time, high pH, and low compressive strength. It possesses some antibacterial and antifungal properties, depending on its powder-to-liquid ratio.
MTA is a bioactive material that influences its surrounding environment.
The present randomized, controlled prospective study evaluated the histomorphological response of human dental pulps capped with two grey mineral trioxide aggregate (MTA) compounds.
Pulp exposures were performed on the occlusal floor of 40 human permanent pre-molars. The pulp was capped either with ProRoot (Dentsply) or MTA-Angelus (Angelus) and restored with zinc oxide eugenol cement. After 30 and 60 days, teeth were extracted and processed for histological examination and the effects on the pulp were scored. The data were subjected to Kruskal-Wallis and Conover tests (alpha = 0.05).
In five out of the 40 teeth bacteria were present in pulp tissue. No significant difference was observed between the two materials (P > 0.05) in terms of overall histological features (hard tissue bridge, inflammatory response, giant cells and particles of capping materials). Overall, 94% and 88% of the specimens capped with MTA-Angelus and ProRoot, respectively, showed either total or partial hard tissue bridge formation (P > 0.05).
Both commercial materials ProRoot (Dentsply) and MTA-Angelus (Angelus) produced similar responses in the pulp when used for pulp capping in intact, caries-free teeth.
To report the treatment and follow-up of a maxillary central incisor with internal resorption managed by root canal treatment, white mineral trioxide aggregate (MTA) repair and a fibre-glass post for reinforcement.
This study presents a case of extensive internal root resorption affecting tooth 11 (FDI) in a 28-year-old male patient, with a history of trauma in that region. The substantial loss of tooth structure, including cementum, and a perforation with lateral periodontal communication were complicating factors. Despite a guarded prognosis but encouraged by a healthy periodontal condition, treatment based on reconstructing the tooth with white MTA and a fibre-glass core was carried out. Follow-up radiographs over 20 months demonstrated the maintenance of a functional tooth. The tooth did, however, discolour after MTA treatment.
Because of its insidious pathology, internal root resorption can extend to significant dimensions before being recognized. MTA plus the fitting of a fibre-glass post provided adequate, functional rehabilitation of a compromised tooth for 20 months. Despite the favourable biological and mechanical properties of white MTA, considerable tooth discolouration may occur.
Emphasis has shifted from the "doomed" organ concept of an exposed pulp to one of hope and recovery. The era of vital-pulp therapy has been greatly enhanced with the introduction of calcium hydroxide (CH) products. The sequence of events leading to dentinal bridge formation with various CH formulas is detailed. Those factors usually considered liabilities to direct pulp capping (pulps cariously exposed, contaminated by saliva, previously carious or restored, periodontally involved, or from older patients and primary teeth) are disputed. Those factors that must be considered to improve the success rate of pulp capping are emphasized: control bleeding, make certain the CH contacts vital-pulp tissue, minimize dentinal chip invasion, avoid embolization of CH particles, and be aware of the depth of penetration of the chemical cautery effect.
The aim of this study was to evaluate the human pulp response following direct pulp capping with a current self-etching bonding agent and calcium hydroxide (CH).
Thirty-three sound human premolars had their pulp tissue mechanically exposed. Sterile distilled water was used to control the hemorrhage and exudation from the pulp exposure site. The pulps were capped with Clearfil Liner Bond 2 (CLB-2) or CH and the cavities were filled with a resin composite (Z-100) according to the manufacturer's instructions. After 5, 30 and 120-300 days, the teeth were extracted and processed for microscopic examination.
At short-term, CLB-2 elicited a mild to moderate inflammatory pulp response with dilated and congested blood vessels adjacent to pulp exposure site. With time, macrophages and giant cells engulfing globules and particulates of resinous material displaced into the pulp space were observed. This chronic inflammatory pulp response triggered by fragments of bonding agent displaced into the pulp space did not allow pulp repair interfering with the dentin bridging. On the other hand, pulps capped with CH exhibited an initial organization of elongated pulp cells underneath the coagulation necrosis. Pulp repair and complete dentin bridge formation was observed at long-term evaluation.
The present study demonstrated that CH remains the pulp capping agent of choice for mechanically exposed human pulps. CLB-2 did not allow complete connective tissue repair adjacent to the pulp exposure site. Consequently, this bonding agent cannot be recommended for pulp therapy of sound human teeth.
To evaluate the effects of current resin-modified glass-ionomer cements (RMGICs) applied on culture of cells or implanted into subcutaneous tissue of rats.
Experiment 1 - Thirty round-shaped samples of every RMGICs: Rely X Luting Cement (RL), Vitremer (VM), and Vitrebond (VB) were placed into wells with 1.1 mL of culture medium (DMEM), and incubated for 24, 48 or 72 h. The extracts from every sample were applied on the MDPC-23 cells. Fresh DMEM was used as control group. The MTT assay was carried out for mitochondrial respiration. Experiment 2 - Fifty-four polyethylene tubes filled with the experimental materials were implanted into the dorsal subcutaneous tissue of rats. At 7, 30, and 90 days the animals were killed and the biopsies were processed for histological evaluation.
Experiment--Both time of elution and material significantly influenced cell respiratory activity. In general, the extracts obtained at 24 h were less cytotoxic than 48 and 72 h incubation. The cytotoxic effect of VM and RL were not statistically different (p < 0.05) for the 24-hour period. VB showed the highest cytotoxic effect. Experiment 2--All RMGICs elicited at 7 days a moderate to intense inflammatory reaction which decreased over time. However, connective healing occurred for most of samples at 90-day evaluation.
Glass-ionomer cements may cause noticeable inflammatory response when in direct contact to connective tissue. The toxic effects of this kind of soluble material depend on the amount of components released in the aqueous environment.
This study evaluated and compared the pH, radiopacity, setting time, solubility, dimensional change, and compressive strength of ProRoot MTA (PMTA), ProRoot MTA (tooth colored formula) (WMTA), white Portland cement (WP), and ordinary Portland cement (OP). The results showed that PMTA and Portland cement have very similar physical properties. However, the radiopacity of Portland cement is much lower than that of PMTA. The compressive strength of PMTA was greater than Portland cement at 28 days. The major constituent of PMTA is Portland cement. Given the low cost of Portland cement and similar properties when compared to PMTA, it is reasonable to consider Portland cement as a possible substitute for PMTA in endodontic applications. However, industrially manufactured Portland cement is not approved currently for use in the United States and therefore no clinical recommendation can be made for its use in the human body. Further in vitro and in vivo tests, especially with regards its biocompatibility, should be conducted to ascertain if it meets the FDA requirements for use as a medical device.
The purpose of this study was to compare the biocompatibility of amalgam, gray MTA and white MTA in the connective tissue of rats. We used 45 Sprague-Dawley rats in this study. The rats were divided into three groups. Root end filling materials were placed in polyethylene tubes and inserted into the rats' connective tissue through incisions. The rats were sacrificed after 3 days, 1 wk, and 3 wk, respectively. Histologic samples were sectioned in 5-mum thicknesses and stained with hematoxylin and eosin. Kruskal-Wallis test was used for statistical analysis. The results showed that after 3 days, white MTA was more biocompatible than gray MTA and amalgam. After 1 week, gray MTA was more biocompatible than white MTA and Amalgam. After 3 wk, there were no significant differences between experimental groups and the control group.
The aim of this study was to evaluate the influence of calcium chloride (CaCl(2)) on the sealing ability of three Mineral Trioxide Aggregate (MTA) cements, ProRoot MTA, MTA-Angelus, and radiopaque White Portland cement (WPC), for retrograde root filling. Seventy roots of extracted single-rooted teeth were instrumented and obturated. After sectioning the samples at 2 mm from the apex, they received one layer of Araldite and two coats of nail enamel, except for the apical dentinal surface submitted to apicectomy. Standardized retrograde cavities were prepared, filled with one of the materials, and immersed in 0.2% Rhodamine B solution for 72 hours. Dye leakage was analyzed on a light microscope with ocular micrometer. Kruskal-Wallis and Miller tests were used to compare groups arranged in increasing order of leakage, according to mean rank of scores: WPC+CaCl(2), MTA-Angelus+CaCl(2), ProRoot MTA+CaCl(2), MTA-Angelus, ProRoot MTA, and WPC. CaCl(2) improved the sealing ability of all three MTA cements.
Mineral trioxide aggregate (MTA) fulfills many of the ideal properties of a root-end filling material. However, the composition of this material often makes MTA difficult to use, a direct result of its granular consistency, slow setting time, and initial looseness. Additives used by the Portland cement (PC) industry to increase PC's plasticity and decrease its setting time were added first to PC and then to gray MTA in an attempt to improve MTA's handling characteristics, with the combination providing the best handling characteristics tested for its effect on compressive strength (for changes in the original material's properties) and decrease in setting time. An admix of 1% methylcellulose and 2% calcium chloride resulted in a mix of chemically modified MTA that, when compared with unmodified MTA, (1) handled similarly to a reinforced zinc oxide-eugenol cement, (2) gave an approximately equal compressive strength, and (3) set one third faster (57 +/- 3 minutes).
This study evaluated the histomorphologic response of human dental pulps capped with mineral trioxide aggregate (MTA) and Ca(OH)2 cement (CH). Pulp exposures were performed on the occlusal floor of 40 human permanent premolars. After that, the pulp was capped either with CH or MTA and restored with composite resin. After 30 and 60 days, teeth were extracted and processed for histologic exam and categorized in a histologic score system. The data were subjected to Kruskal-Wallis and Conover tests (alpha = .05). All groups performed well in terms of hard tissue bridge formation, inflammatory response, and other pulpal findings. However, a lower response of CH30 was observed for the dentin bridge formation, when compared with MTA30 and MTA60 groups. Although the pulp healing with calcium hydroxide was slower than that of MTA, both materials were successful for pulp capping in human teeth.
To characterize the hydration products of white mineral trioxide aggregate (MTA).
Mineral trioxide aggregate, white Portland cement and bismuth oxide were evaluated using X-ray diffraction (XRD) analysis and Rietveld XRD. The cements were tested un-hydrated and after hydration and curing for 30 days at 37 degrees C. Analysis of hydrated cement leachate was performed weekly for five consecutive weeks from mixing using inductively coupled plasma atomic emission spectroscopy after which the cements were viewed under the scanning electron microscope to evaluate the cement microstructure. Quantitative energy dispersive analysis with X-ray was performed and atomic ratios were plotted.
Both Portland cement and MTA produced calcium silicate hydrate (C-S-H) and calcium hydroxide (CH) on hydration. The tricalcium aluminate levels were low for MTA which resulted in reduced production of ettringite and monosulphate. On hydration the bismuth level in the hydrated MTA decreased; bismuth oxide replaced the silica in the C-S-H and was leached out once the C-S-H decomposed with time. Both MTA and Portland cement released a high amount of calcium ions which decreased in amount over the 5-week period.
The hydration mechanism of MTA is different to that of Portland cement. In MTA the bismuth oxide is bound to the C-S-H and is leached out from the cement with time as the C-S-H decomposes. MTA produces a high proportion of calcium ions from CH a by-product of hydration and also by decomposition of C-S-H. The release of calcium ions reduces with time.
A histological study of pulp reaction to various water/powder ratios of white mineral trioxide aggregate as pulp-capping Basic Research—Technology
- A Shahravan
- Sp Jalali
- M Torabi
Shahravan A, Jalali SP, Torabi M, et al. A histological study of pulp reaction to
various water/powder ratios of white mineral trioxide aggregate as pulp-capping
Basic Research—Technology
Biocompatibility of Calcium Aluminate Cement material in human teeth: a double-blinded, randomized controlled trial
- Joe Volume
JOE — Volume -, Number -, -2014
Biocompatibility of Calcium Aluminate Cement
material in human teeth: a double-blinded, randomized controlled trial. Int Endod J
2011;44:1029–33.
International Standards Organization Dentistry: evaluation of biocompatibility of medical devices used in dentistry
International Standards Organization. Dentistry: evaluation of biocompatibility of
medical devices used in dentistry. ISO 7405 2007;1:34.
Pires-de-Souza Fde C. Solubility and disintegration of new calcium aluminate cement (EndoBinder) containing different radiopacifying agents
- Garcia Lda
- F Chinelatti
- Ma Rossetto
Garcia Lda F, Chinelatti MA, Rossetto HL, Pires-de-Souza Fde C. Solubility and disintegration of new calcium aluminate cement (EndoBinder) containing different
radiopacifying agents. J Endod 2014;40:261–5.
Comparison of the physical and mechanical properties of MTA and Portland cement
- I Islam
- Hk Chng
- Au Yap
Islam I, Chng HK, Yap AU. Comparison of the physical and mechanical properties of
MTA and Portland cement. J Endod 2006;32:193–7.
Staining susceptibility of new calcium aluminate cement (EndoBinder) in teeth: a 1-year in vitro study
- Garcia Lda
- F Aguilar
- Fg Rossetto
Garcia Lda F, Aguilar FG, Rossetto HL, et al. Staining susceptibility of new calcium
aluminate cement (EndoBinder) in teeth: a 1-year in vitro study. Dent Traumatol
2013;29:383–8.
Characterization of hydration products of mineral trioxide aggregate.
- Camilleri J.
Camilleri J. Characterization of hydration products of mineral trioxide aggregate. Int
Endod J 2008;41:408–17.